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Tamari R, McLornan DP, Ahn KW, Estrada-Merly N, Hernández-Boluda JC, Giralt S, Palmer J, Gale RP, DeFilipp Z, Marks DI, van der Poel M, Verdonck LF, Battiwalla M, Diaz MA, Gupta V, Ali H, Litzow MR, Lazarus HM, Gergis U, Bashey A, Liesveld J, Hashmi S, Pu JJ, Beitinjaneh A, Bredeson C, Rizzieri D, Savani BN, Abid MB, Ganguly S, Agrawal V, Ulrike Bacher V, Wirk B, Jain T, Cutler C, Aljurf M, Kindwall-Keller T, Kharfan-Dabaja MA, Hildebrandt GC, Pawarode A, Solh MM, Yared JA, Grunwald MR, Nathan S, Nishihori T, Seo S, Scott BL, Nakamura R, Oran B, Czerw T, Yakoub-Agha I, Saber W. A simple prognostic system in patients with myelofibrosis undergoing allogeneic stem cell transplantation: a CIBMTR/EBMT analysis. Blood Adv 2023; 7:3993-4002. [PMID: 37134306 PMCID: PMC10410129 DOI: 10.1182/bloodadvances.2023009886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023] Open
Abstract
To develop a prognostic model for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) for myelofibrosis (MF), we examined the data of 623 patients undergoing allo-HCT between 2000 and 2016 in the United States (the Center for International Blood and Marrow Transplant Research [CIBMTR] cohort). A Cox multivariable model was used to identify factors prognostic of mortality. A weighted score using these factors was assigned to patients who received transplantation in Europe (the European Bone Marrow Transplant [EBMT] cohort; n = 623). Patient age >50 years (hazard ratio [HR], 1.39; 95% confidence interval [CI], 0.98-1.96), and HLA-matched unrelated donor (HR, 1.29; 95% CI, 0.98-1.7) were associated with an increased hazard of death and were assigned 1 point. Hemoglobin levels <100 g/L at time of transplantation (HR, 1.63; 95% CI, 1.2-2.19) and a mismatched unrelated donor (HR, 1.78; 95% CI, 1.25-2.52) were assigned 2 points. The 3-year overall survival (OS) in patients with a low (1-2 points), intermediate (3-4 points), and high score (5 points) were 69% (95% CI, 61-76), 51% (95% CI, 46-56.4), and 34% (95% CI, 21-49), respectively (P < .001). Increasing score was predictive of increased transplant-related mortality (TRM; P = .0017) but not of relapse (P = .12). The derived score was predictive of OS (P < .001) and TRM (P = .002) but not of relapse (P = .17) in the EBMT cohort as well. The proposed system was prognostic of survival in 2 large cohorts, CIBMTR and EBMT, and can easily be applied by clinicians consulting patients with MF about the transplantation outcomes.
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Affiliation(s)
- Roni Tamari
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Donal P. McLornan
- Department of Medicine, University College Hospital, London, United Kingdom
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Noel Estrada-Merly
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sergio Giralt
- Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeanne Palmer
- Department of Medicine, Mayo Clinic Arizona and Phoenix Children’s Hospital, Phoenix, AZ
| | - Robert Peter Gale
- Department of Immunology and Inflammation, Haematology Centre, Imperial College London, London, United Kingdom
| | - Zachariah DeFilipp
- Department of Medicine, Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA
| | - David I. Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Marjolein van der Poel
- Division of Hematology, Department of Internal Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F. Verdonck
- Department of Hematology/Oncology, Isala Clinic, Zwolle, The Netherlands
| | - Minoo Battiwalla
- Outcomes Research, Sarah Cannon Blood Cancer Network, Nashville, TN
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - Vikas Gupta
- Department of Internal Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Haris Ali
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Mark Robert Litzow
- Division of Hematology and Transplant Center, Mayo Clinic, Rochester, MN
| | - Hillard M. Lazarus
- Department of Hematology and Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH
| | - Usama Gergis
- Division of Hematological Malignancies, Department of Medicine Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Asad Bashey
- Department of Medicine, Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Jane Liesveld
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Jeffrey J. Pu
- Department of Medicine, Banner University Medical Center Tucson, Syracuse, NY
| | - Amer Beitinjaneh
- Divison of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Christopher Bredeson
- Department of Medicine, The Ottawa Hospital Transplant & Cellular Therapy Program, Ottawa, ON, Canada
| | | | - Bipin N. Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Muhammad Bilal Abid
- Divisions of Hematology/Oncology & Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Siddhartha Ganguly
- Department of Medicine, Houston Methodist Hospital and Cancer Center, Houston, TX
| | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Vera Ulrike Bacher
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baldeep Wirk
- Department of Medicine, Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, PA
| | - Tania Jain
- Division of Hematological Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Corey Cutler
- Stem Cell Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, MA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Tamila Kindwall-Keller
- Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, VA
| | - Mohamed A. Kharfan-Dabaja
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
| | | | - Attaphol Pawarode
- Division of Hematology/Oncology, Department of Internal Medicine, Blood and Marrow Transplantation Program, University of Michigan Medical School, Ann Arbor, MI
| | - Melhem M. Solh
- The Blood and Marrow Transplant Program, Northside Hospital Cancer Institute, Atlanta, GA
| | - Jean A. Yared
- Division of Hematology/Oncology, Department of Medicine, Transplantation & Cellular Therapy Program, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD
| | - Michael R. Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Sunita Nathan
- Department of Internal Medicine, Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Bart L. Scott
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ryotaro Nakamura
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Betul Oran
- Division of Cancer Medicine, Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tomasz Czerw
- Department of Haematology and BMT, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | | | - Wael Saber
- Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
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Liu X, Ren F, Li S, Zhang N, Pu JJ, Zhang H, Xu Z, Tan Y, Chen X, Chang J, Wang H. Acute myeloid leukemia cells and MSC-derived exosomes inhibiting transformation in myelodysplastic syndrome. Discov Oncol 2023; 14:115. [PMID: 37382733 DOI: 10.1007/s12672-023-00714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023] Open
Abstract
AIMS To investigate the mechanism of exosomes' role in the transformation of MDS to AML. METHODS Exosomes in culture supernatants of MDS and AML cell lines, were extracted by ultrafiltration and identified in three ways: morphology, size, and exosome protein surface markers. Exosomes from AML cell lines were then co-cultured with MDS cell lines and their impacts on MDS cell microenvironment, proliferation, differentiation, cell cycle, and apoptosis were analyzed by CCK-8 assay and flow cytometry. Furthermore, exosomes from MSC were extracted for further authentication. RESULTS The transmission electron microscopy, nanoparticle tracking analysis, Western blotting, and flow cytometry methods all verify that ultrafiltration is a reliable method to extract exosomes in the culture medium. Exosomes from AML cell lines inhibit the proliferation of MDS cell lines, block cell cycle progression, and promote apoptosis and cell differentiation. It also leads to increased secretion of tumor necrosis factor-α (TNF-α) and reactive oxygen species (ROS) in MDS cell lines. In addition, MSC-derived exosomes were found to inhibit the proliferation of MDS cell lines, arrest cell cycle progression, promote apoptosis, and inhibit differentiation. CONCLUSION Ultrafiltration is a proper methodology in extracting exosomes. The exosomes of AML origin and MSC origin may play a role in MDS leukemia transformation via targeting TNF-α/ROS-Caspase3 pathway.
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Affiliation(s)
- Xiaoli Liu
- Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, People's Republic of China
| | - Fanggang Ren
- Laboratory of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China.
- The Key Laboratory of Molecular Diagnosis and Treatment of Hematological Diseases of Shanxi Province, 382 Wuyi Road, Taiyuan, 030001, People's Republic of China.
| | - Shuo Li
- Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, People's Republic of China
| | - Na Zhang
- Department of Medical Laboratory, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jeffrey J Pu
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Hongyu Zhang
- Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, People's Republic of China
| | - Zhifang Xu
- Laboratory of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
- The Key Laboratory of Molecular Diagnosis and Treatment of Hematological Diseases of Shanxi Province, 382 Wuyi Road, Taiyuan, 030001, People's Republic of China
| | - Yanhong Tan
- Laboratory of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
- The Key Laboratory of Molecular Diagnosis and Treatment of Hematological Diseases of Shanxi Province, 382 Wuyi Road, Taiyuan, 030001, People's Republic of China
| | - Xiuhua Chen
- Laboratory of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
- The Key Laboratory of Molecular Diagnosis and Treatment of Hematological Diseases of Shanxi Province, 382 Wuyi Road, Taiyuan, 030001, People's Republic of China
| | - Jianmei Chang
- Laboratory of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
- The Key Laboratory of Molecular Diagnosis and Treatment of Hematological Diseases of Shanxi Province, 382 Wuyi Road, Taiyuan, 030001, People's Republic of China
| | - Hongwei Wang
- Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, People's Republic of China.
- Laboratory of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China.
- The Key Laboratory of Molecular Diagnosis and Treatment of Hematological Diseases of Shanxi Province, 382 Wuyi Road, Taiyuan, 030001, People's Republic of China.
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Wang A, Liu J, Pu JJ. Novel agents and evolving strategies in myelofibrotive neoplasm: an update from 2022 ASH annual conference. J Hematol Oncol 2023; 16:53. [PMID: 37173704 PMCID: PMC10182587 DOI: 10.1186/s13045-023-01446-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Myelofibrosis (MF) is a disorder characterized by the proliferation of myeloid precursors, commonly due to overactive JAK signaling. The discovery of the JAK2V617F mutation and subsequent development of JAK inhibitors (JAKi) results in reduced spleen size, improved symptom, and enhanced survival in MF patients. However, there are unmet needs of additional novel targeted therapies for this incurable disease due to the limited utility of first-generation JAKis, which are associated with dose-limiting cytopenia and disease recurrence. New targeted treatment strategies for MF are on the horizon. We are here to discuss the latest clinical research findings presented in the 2022 ASH Annual Meeting.
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Affiliation(s)
- Andrew Wang
- Pennsylvania State University, University Park, PA, 16802, USA
| | - James Liu
- Hopkins School, 986 Forest Road, New Haven, CT, 06515, USA
| | - Jeffrey J Pu
- Boston VA Medical Center/Brigham and Woman Hospital, Harvard Medical School, 1400 VFW Parkway Building 3, Suite 2B-115, Boston, MA, 02132, USA.
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Wang H, Berger KN, Miller EL, Fu W, Broglie L, Goldman FD, Konig H, Lim SJ, Berg AS, Talano JA, Comito MA, Farag SS, Pu JJ. The impacts of total body irradiation on umbilical cord blood hematopoietic stem cell transplantation. Ther Adv Hematol 2023; 14:20406207231170708. [PMID: 37151808 PMCID: PMC10161310 DOI: 10.1177/20406207231170708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Umbilical cord blood hematopoietic stem cells are commonly used for hematopoietic system reconstitution in recipients after umbilical cord blood transplantation (UCBT). However, the optimal conditioning regimen for UCBT remains a topic of debate. The exact impact of total body irradiation (TBI) as a part of conditioning regimens remains unknown. Objectives The aim of this study was to evaluate the impacts of TBI on UCBT outcomes. Design This was a multi-institution retrospective study. Methods A retrospective analysis was conducted on the outcomes of 136 patients receiving UCBT. Sixty-nine patients received myeloablative conditioning (MAC), in which 33 underwent TBI and 36 did not, and 67 patients received reduced-intensity conditioning (RIC), in which 43 underwent TBI and 24 did not. Univariate and multivariate analyses were conducted to compare the outcomes and the post-transplant complications between patients who did and did not undergo TBI in the MAC subgroup and RIC subgroup, respectively. Results In the RIC subgroup, patients who underwent TBI had superior overall survival (adjusted hazard ratio [aHR] = 0.25, 95% confidence interval [CI]: 0.09-0.66, p = 0.005) and progression-free survival (aHR = 0.26, 95% CI: 0.10-0.66, p = 0.005). However, in the MAC subgroup, there were no statistically significant differences between those receiving and not receiving TBI. Conclusion In the setting of RIC in UCBT, TBI utilization can improve overall survival and progression-free survival. However, TBI does not show superiority in the MAC setting.
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Affiliation(s)
- Hao Wang
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kristin N. Berger
- Penn State Hershey Cancer Institute, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Elizabeth L. Miller
- Penn State Hershey Cancer Institute, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Wei Fu
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Larisa Broglie
- Division of Hematology and Oncology - Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Frederick D. Goldman
- Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, AB, USA
| | - Heiko Konig
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Su Jin Lim
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Arthur S. Berg
- Penn State Hershey Cancer Institute, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Julie-An Talano
- Division of Hematology and Oncology - Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melanie A. Comito
- Penn State Hershey Cancer Institute, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Sherif S. Farag
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Jeffrey J. Pu
- Cancer Center, The University of Arizona, 1515 N Campbell Avenue, Room#1968C, Tucson, AZ 85724, USA
- Penn State Hershey Cancer Institute, College of Medicine, Pennsylvania State University, Hershey, PA, USA
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Wu G, Guo S, Luo Q, Wang X, Deng W, Ouyang G, Pu JJ, Lei W, Qian W. Preclinical evaluation of CD70-specific CAR T cells targeting acute myeloid leukemia. Front Immunol 2023; 14:1093750. [PMID: 36845088 PMCID: PMC9950117 DOI: 10.3389/fimmu.2023.1093750] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
Backgrounds Chimeric antigen receptor (CAR)-T cell therapy has achieved unprecedented success in treating hematopoietic malignancies. However, this cell therapy is hampered in treating acute myeloid leukemia (AML) due to lack of ideal cell surface targets that only express on AML blasts and leukemia stem cells (LSCs) but not on normal hematopoietic stem cells (HSCs). Methods We detected the CD70 expression on the surfaces of AML cell lines, primary AML cells, HSC, and peripheral blood cells and generated a second-generation CD70-specific CAR-T cells using a construct containing a humanized 41D12-based scFv and a 41BB-CD3ζ intracellular signaling domain. Cytotoxicity, cytokine release, and proliferation in antigen stimulation, CD107a assay, and CFSE assays were used to demonstrate the potent anti-leukemia activity in vitro. A Molm-13 xenograft mouse model was established to evaluate the anti-leukemic activity of CD70 CAR-T in vivo. CFU assay was explored to assess the safety of CD70 CAR-T on HSC. Results CD70 heterogeneously expressed on AML primary cells, including leukemia blasts, leukemic progenitor, and stem cells, but not expressed on normal HSCs and majority of blood cells. Anti-CD70 CAR-T cells exhibited potent cytotoxicity, cytokines production, and proliferation when incubated with CD70+ AML cell lines. It also displayed robust anti-leukemia activity and prolonged survival in Molm-13 xenograft mouse model. However, such CAR-T cell therapy did not completely eliminate leukemia in vivo. Discussion Our study reveals that anti-CD70 CAR-T cells are a new potential treatment for AML. However, such CAR-T cell therapy did not completely eliminate leukemia in vivo, suggesting that future studies aiming to generate innovative combinatorial CAR constructs or to increase CD70 expression density on leukemia cell surface to prolong the life-span of CAR-T cells in the circulation will be needed in order to optimize CAR-T cell responses for AML.
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Affiliation(s)
- Gongqiang Wu
- Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang People’s Hospital, Dongyang, Zhejiang, China
| | - Shanshan Guo
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qian Luo
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoxia Wang
- Department of Hematology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang People’s Hospital, Dongyang, Zhejiang, China
| | - Wenhai Deng
- Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guifang Ouyang
- Hematology Department of Ningbo First Hospital, Ningbo Clinical Research Center for Hematologic Malignancies, Ningbo, China
| | - Jeffrey J. Pu
- Department of Medicine, University of Arizona National Cancer Institute (NCI) Designated Comprehensive Cancer Center, Tucson, AZ, United States,*Correspondence: Jeffrey J. Pu, ; Wen Lei, ; Wenbin Qian,
| | - Wen Lei
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China,*Correspondence: Jeffrey J. Pu, ; Wen Lei, ; Wenbin Qian,
| | - Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China,Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China,*Correspondence: Jeffrey J. Pu, ; Wen Lei, ; Wenbin Qian,
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Dashkevych U, Munugala N, Iftikhar A, Khurana S, Kumar A, Gowin K, Amaraneni A, Krishnadasan R, Pu JJ, Katsanis E, Husnain M. Role of Anakinra in the Management of Steroid Refractory High Grade Immune Effector Cell-Associated Neurotoxicity Syndrome after Anti-CD 19 CAR-T Cell Therapy, a Single Center Experience. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00257-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Dhaliwal A, Eller VF, Pu JJ. Immunocompetent Patient With Primary Bone Marrow Hodgkin Lymphoma. J Med Cases 2022; 13:427-431. [PMID: 36258707 PMCID: PMC9534194 DOI: 10.14740/jmc3973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/04/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Armaan Dhaliwal
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Vanessa F. Eller
- University of Arizona NCI Designated Comprehensive Cancer Center, Tucson, AZ, USA
| | - Jeffrey J. Pu
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
- University of Arizona NCI Designated Comprehensive Cancer Center, Tucson, AZ, USA
- Corresponding Author: Jeffrey J. Pu, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.
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LeBlanc FR, Hasanali ZS, Stuart A, Shimko S, Sharma K, Leshchenko VV, Parekh S, Fu H, Zhang Y, Martin MM, Kester M, Fox T, Liao J, Loughran TP, Evans J, Pu JJ, Spurgeon SE, Aladjem MI, Epner EM. Combined epigenetic and immunotherapy for blastic and classical mantle cell lymphoma. Oncotarget 2022; 13:986-1002. [PMID: 36093297 PMCID: PMC9450988 DOI: 10.18632/oncotarget.28258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
Classical MCL (cMCL) constitutes 6-8% of all B cell NHL. Despite recent advances, MCL is incurable except with allogeneic stem cell transplant. Blastic mantle cell lymphoma (bMCL) is a rarer subtype of cMCL associated with an aggressive clinical course and poor treatment response, frequent relapse and poor outcomes. We treated 13 bMCL patients with combined epigenetic and immunotherapy treatment consisting of vorinostat, cladribine and rituximab (SCR). We report an increased OS greater than 40 months with several patients maintaining durable remissions without relapse for longer than 5 years. This is remarkably better then current treatment regimens which in bMCL range from 14.5-24 months with conventional chemotherapy regimens. We demonstrate that the G/A870 CCND1 polymorphism is predictive of blastic disease, nuclear localization of cyclinD1 and response to SCR therapy. The major resistance mechanisms to SCR therapy are loss of CD20 expression and evasion of treatment by sanctuary in the CNS. These data indicate that administration of epigenetic agents improves efficacy of anti-CD20 immunotherapies. This approach is promising in the treatment of MCL and potentially other previously treatment refractory cancers.
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Affiliation(s)
- Francis R. LeBlanc
- 1Department of Medicine, Pennsylvania State University College of Medicine and Penn State Hershey Cancer Institute, Hershey, PA 17033, USA,*Co-first authors,Correspondence to:Francis R. LeBlanc, email:
| | - Zainul S. Hasanali
- 1Department of Medicine, Pennsylvania State University College of Medicine and Penn State Hershey Cancer Institute, Hershey, PA 17033, USA,*Co-first authors
| | - August Stuart
- 2Department of Hematology/Oncology, Penn State Hershey Cancer Institute, Hershey, PA 17033, USA
| | - Sara Shimko
- 2Department of Hematology/Oncology, Penn State Hershey Cancer Institute, Hershey, PA 17033, USA
| | - Kamal Sharma
- 3BayCare Medical Group, Cassidy Cancer Center, Winter Haven, FL 33881, USA
| | - Violetta V. Leshchenko
- 4Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samir Parekh
- 4Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Haiqing Fu
- 5Developmental Therapeutics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Ya Zhang
- 5Developmental Therapeutics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Melvenia M. Martin
- 5Developmental Therapeutics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
| | - Mark Kester
- 6Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
| | - Todd Fox
- 6Department of Pharmacology, University of Virginia, Charlottesville, VA 22908, USA
| | - Jiangang Liao
- 7Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Thomas P. Loughran
- 8Department of Medicine/Hematology-Oncology, UVA Cancer Center, Charlottesville, VA 22908, USA
| | - Juanita Evans
- 9Department of Anatomic Pathology, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Jeffrey J. Pu
- 10Department of Medicine and Cancer Center, University of Arizona College of Medicine, Tucson, AZ 85724, USA
| | - Stephen E. Spurgeon
- 11Department of Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Mirit I. Aladjem
- 5Developmental Therapeutics Branch, Center for Cancer Research, NCI, NIH, Bethesda, MD 20892, USA
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LaBella D, Regan S, Konig H, Egan DN, Bailey NA, Mawad R, Gilbert M, Pagel JM, Pu JJ. The role of adjuvant chemotherapy in the management of acute promyelocytic leukemia differentiation syndrome. Front Oncol 2022; 12:911745. [PMID: 35992790 PMCID: PMC9383033 DOI: 10.3389/fonc.2022.911745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Acute Promyelocytic Leukemia (APL) is characterized by the t(15;17) chromosomal translocation resulting in a PML-RARA fusion protein. The all-trans-retinoic acid (ATRA) and Arsenic Trioxide (ATO) only regimens have demonstrated success in treating low- and intermediate-risk patients. However, induction with ATRA/ATO only regimens have been showing increased incidence of differentiation syndrome (DS), a potentially lethal complication, traditionally treated with dexamethasone. We conducted a three-institution retrospective study, aiming to evaluate the role of short-term adjuvant chemotherapy in managing moderate DS for patients with low- or intermediate-risk APL initially treated with ATRA/ATO only protocols. We evaluated the difference in incidence and duration of moderate DS in APL patients who were treated with ATRA/ATO with or without adjuvant chemotherapy. 57 low- or intermediate-risk APL patients were retrospectively identified and included for this study; 36 patients received ATRA/ATO only induction treatment, and 21 patients received ATRA/ATO/adjuvant chemotherapy combination induction therapy. Similar proportions of patients experienced DS in both groups (66.7% vs. 81.0%, P = 0.246). The median duration of DS resolution in patients receiving ATRA/ATO only was 17 days (n = 23), and in patients receiving combination therapy was 8 days (n = 16) (P = 0.0001). The lengths of hospital stay in patients receiving ATRO/ATO only was 38 days (n = 7), and in patients receiving combination therapy was 14 days (n = 17) (P = 0.0007). In conclusion, adding adjuvant chemotherapy to ATRA/ATO only protocol may reduce the duration of DS and the length of hospital stay during APL induction treatment.
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Affiliation(s)
- Dominic LaBella
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, United States
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Samuel Regan
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Heiko Konig
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Daniel N. Egan
- Department of Medicine, Swedish Medical Center, Seattle, WA, United States
| | - Neil A. Bailey
- Department of Medicine, Swedish Medical Center, Seattle, WA, United States
| | - Raya Mawad
- Department of Medicine, Swedish Medical Center, Seattle, WA, United States
| | - Morgan Gilbert
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - John M. Pagel
- Department of Medicine, Swedish Medical Center, Seattle, WA, United States
| | - Jeffrey J. Pu
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, United States
- Department of Medicine, University of Arizona National Cancer Institute (NCI) Designated Comprehensive Cancer Center, Tucson, AZ, United States
- *Correspondence: Jeffrey J. Pu, ;
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10
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Pu JJ, Berger KN, Wang H, Miller EL, Fu W, Broglie L, Konig H, Goldman F, Talano JA, Farag SS, Comito M. Impacts of Total Body Irradiation in Allogeneic Umbilical Cord Blood Hematopoietic Stem Cell Transplant with Reduced Intensity Conditioning. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Pu JJ, Savani M, Huang N, Epner EM. Mantle cell lymphoma management trends and novel agents: where are we going? Ther Adv Hematol 2022; 13:20406207221080743. [PMID: 35237397 PMCID: PMC8882940 DOI: 10.1177/20406207221080743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
The heterogeneity in disease pathology, the unpredictability in disease
prognosis, and the variability in response to therapy make mantle cell lymphoma
(MCL) a focus of novel therapeutic development. MCL is characterized by
dysregulated expression of cyclin D1 through a chromosome
t(11;14) translocation. MCL international prognostic index
(MIPI), ki-67 proliferation index, and TP53
mutation status are currently utilized for prognostication. With advances in
pharmacokinetic analysis and drug discovery, treatment strategy has evolved from
chemotherapy to combination of targeted, epigenetic, and immune therapies. In
this review, we discuss investigational and newly approved treatment approaches.
In a short time, the US Food and Drug Administration (FDA) has approved five
agents for the treatment of MCL: lenalidomide, an immunomodulatory agent;
bortezomib, a proteasome inhibitor; and ibrutinib, acalabrutinib, and
zanubrutinib, all Bruton kinase inhibitors. Epigenetic agents (e.g. cladribine
and vorinostat), mammalian target of rapamycin (mTOR) inhibitors (e.g.
temsirolimus and everolimus), and monoclonal antibodies and/or antibody-drug
conjugates (e.g. obinutuzumab, polatuzumab, and ublituximab) are promising
therapeutic agents currently under clinical trial investigation. Most recently,
chimeric antigen receptor (CAR)-T cell therapy and bispecific T-cell engager
(BiTE) therapy even open a new venue for MCL treatment. However, due to its
intricate pathology nature and high relapse incidence, there are still unmet
needs in developing optimal therapeutic strategies for both frontline and
relapsed/refractory settings. The ultimate goal is to develop innovative
personalized combination therapy approaches for the purpose of delivering
precision medicine to cure this disease.
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Affiliation(s)
- Jeffrey J. Pu
- University of Arizona Cancer Center, 1515 N Campbell Avenue, Room #1968C, Tucson, AZ 85724, USA
| | - Malvi Savani
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Nick Huang
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Elliot M. Epner
- Penn State Hershey Cancer Institute, 100 University Drive, Hershey, PA, USA
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12
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Teye EK, Lu S, Chen F, Yang W, Abraham T, Stairs DB, Wang HG, Yochum GS, Brodsky RA, Pu JJ. PIGN spatiotemporally regulates the spindle assembly checkpoint proteins in leukemia transformation and progression. Sci Rep 2021; 11:19022. [PMID: 34561473 PMCID: PMC8463542 DOI: 10.1038/s41598-021-98218-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/06/2021] [Indexed: 12/19/2022] Open
Abstract
Phosphatidylinositol glycan anchor biosynthesis class N (PIGN) has been linked to the suppression of chromosomal instability. The spindle assembly checkpoint complex is responsible for proper chromosome segregation during mitosis to prevent chromosomal instability. In this study, the novel role of PIGN as a regulator of the spindle assembly checkpoint was unveiled in leukemic patient cells and cell lines. Transient downregulation or ablation of PIGN resulted in impaired mitotic checkpoint activation due to the dysregulated expression of spindle assembly checkpoint-related proteins including MAD1, MAD2, BUBR1, and MPS1. Moreover, ectopic overexpression of PIGN restored the expression of MAD2. PIGN regulated the spindle assembly checkpoint by forming a complex with the spindle assembly checkpoint proteins MAD1, MAD2, and the mitotic kinase MPS1. Thus, PIGN could play a vital role in the spindle assembly checkpoint to suppress chromosomal instability associated with leukemic transformation and progression.
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Affiliation(s)
- Emmanuel K Teye
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Shasha Lu
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangyuan Chen
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenrui Yang
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA.,Institute of Hematology, Peking Union Medical College, Tianjin, China
| | - Thomas Abraham
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Douglas B Stairs
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Hong-Gang Wang
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Gregory S Yochum
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Robert A Brodsky
- Division of Hematology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jeffrey J Pu
- Penn State Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA. .,University of Arizona Cancer Center, 1515 N Campbell Avenue, #1968C, Tucson, AZ, 85724, USA.
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13
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Deng W, Chen P, Lei W, Xu Y, Xu N, Pu JJ, Liang A, Qian W. CD70-targeting CAR-T cells have potential activity against CD19-negative B-cell Lymphoma. Cancer Commun (Lond) 2021; 41:925-929. [PMID: 34313014 PMCID: PMC8441055 DOI: 10.1002/cac2.12201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wenhai Deng
- Key Laboratory of Laboratory Medicine, Ministry of Education, School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, P. R. China
| | - Panpan Chen
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, P. R. China
| | - Wen Lei
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, P. R. China
| | - Yang Xu
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, P. R. China
| | - Nengwen Xu
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, P. R. China
| | - Jeffrey J Pu
- University of Arizona NCI designated Comprehensive Cancer Center, Tucson, Arizona, 85719, USA
| | - Aibin Liang
- Department of Hematology, Tongji Hospital of Tongji University, Shanghai, 200065, P. R. China
| | - Wenbin Qian
- Department of Hematology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, P. R. China.,Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, 310003, P. R. China.,National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, P. R. China
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14
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Hou JZ, Ye JC, Pu JJ, Liu H, Ding W, Zheng H, Liu D. Novel agents and regimens for hematological malignancies: recent updates from 2020 ASH annual meeting. J Hematol Oncol 2021; 14:66. [PMID: 33879198 PMCID: PMC8059303 DOI: 10.1186/s13045-021-01077-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
Antibodies and chimeric antigen receptor-engineered T cells (CAR-T) are increasingly used for cancer immunotherapy. Small molecule inhibitors targeting cellular oncoproteins and enzymes such as BCR-ABL, JAK2, Bruton tyrosine kinase, FLT3, BCL-2, IDH1, IDH2, are biomarker-driven chemotherapy-free agents approved for several major hematological malignancies. LOXO-305, asciminib, "off-the-shelf" universal CAR-T cells and BCMA-directed immunotherapeutics as well as data from clinical trials on many novel agents and regimens were updated at the 2020 American Society of Hematology (ASH) Annual Meeting. Major developments and updates for the therapy of hematological malignancies were delineated at the recent Winter Symposium and New York Oncology Forum from the Chinese American Hematologist and Oncologist Network (CAHON.org). This study summarized the latest updates on novel agents and regimens for hematological malignancies from the 2020 ASH annual meeting.
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Affiliation(s)
- Jing-Zhou Hou
- Hillman Cancer Center, University of Pittsburgh Medical Center (UPMC), 5115 Centre Ave., Fl 4, Pittsburgh, PA 15232 USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
| | - Jing Christine Ye
- Department of Internal Medicine, Hematology/Oncology Division, University of Michigan, Rogel Cancer Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
| | - Jeffrey J. Pu
- Department of Medicine, University of Arizona NCI Designated Comprehensive Cancer Center, Tucson, AZ USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
| | - Hongtao Liu
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Medical Center, 5841 S. Maryland, MC 2115, Chicago, IL 60637-1470 USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
| | - Wei Ding
- Division of Hematology, Mayo Clinic, Rochester, MN 55905 USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
| | - Hong Zheng
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA 17033 USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
| | - Delong Liu
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595 USA
- Chinese American Hematologist and Oncologist Network (CAHON), 555 East Wells Street, Suite 1100, Milwaukee, WI 53202 USA
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15
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Kumar PA, Wazir A, Pu JJ. Resolution of Chronic Immune Thrombocytopenia Purpura after Autologous Hematopoietic Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma. J Med Cases 2021; 12:37-40. [PMID: 33391580 PMCID: PMC7771832 DOI: 10.14740/jmc3607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immune-mediated destruction of platelets that could be triggered by a number of causes. ITPs are usually treated with steroid, immunomodulators or immunosuppressors, and intravenous immunoglobulin therapy though refractory/relapsed status frequently occurs. It was suggested that autologous hematopoietic stem cell transplant (HSCT) after high-dose chemotherapy conditioning might improve ITP patients’ peripheral blood platelet counts via reorganizing disrupted immune balance in the hematopoietic and hematologic systems. In this case report, we describe how a patient, who suffered from both severe thrombocytopenia due to chronic ITP and refractory/relapsed diffuse large B-cell lymphoma (DLBCL), was managed to successfully receive autologous HSCT using carmustine, etoposide, cytarabine and melphalan (BEAM) conditioning regimens and how his chronic ITP was eventually cured after receiving autologous HSCT. This is the first clinical case in the world demonstrating that high-dose BEAM chemotherapy conditioned autologous HSCT could cure chronic ITP while successfully managing refractory/relapse DLBCL. The clinical hematology professionals and the patients will benefit from our experience in managing severe thrombocytopenia while conducting high-dose chemotherapy conditioning and autologous HSCT for DLBCL.
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Affiliation(s)
- Prashanth A Kumar
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.,The authors equally contributed to this manuscript
| | - Ali Wazir
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA.,The authors equally contributed to this manuscript
| | - Jeffrey J Pu
- Department of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
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16
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Cuneo A, Mato AR, Rigolin GM, Piciocchi A, Gentile M, Laurenti L, Allan JN, Pagel JM, Brander DM, Hill BT, Winter A, Lamanna N, Tam CS, Jacobs R, Lansigan F, Barr PM, Shadman M, Skarbnik AP, Pu JJ, Sehgal AR, Schuster SJ, Shah NN, Ujjani CS, Roeker L, Orlandi EM, Billio A, Trentin L, Spacek M, Marchetti M, Tedeschi A, Ilariucci F, Gaidano G, Doubek M, Farina L, Molica S, Di Raimondo F, Coscia M, Mauro FR, de la Serna J, Medina Perez A, Ferrarini I, Cimino G, Cavallari M, Cucci R, Vignetti M, Foà R, Ghia P. Efficacy of bendamustine and rituximab in unfit patients with previously untreated chronic lymphocytic leukemia. Indirect comparison with ibrutinib in a real-world setting. A GIMEMA-ERIC and US study. Cancer Med 2020; 9:8468-8479. [PMID: 32969597 PMCID: PMC7666748 DOI: 10.1002/cam4.3470] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
Limited information is available on the efficacy of front‐line bendamustine and rituximab (BR) in chronic lymphocytic leukemia (CLL) with reduced renal function or coexisting conditions. We therefore analyzed a cohort of real‐world patients and performed a matched adjusted indirect comparison with a cohort of patients treated with ibrutinib. One hundred and fifty‐seven patients with creatinine clearance (CrCl) <70 mL/min and/or CIRS score >6 were treated with BR. The median age was 72 years; 69% of patients had ≥2 comorbidities and the median CrCl was 59.8 mL/min. 17.6% of patients carried TP53 disruption. The median progression‐free survival (PFS) was 45 months; TP53 disruption was associated with a shorter PFS (P = 0.05). The overall survival (OS) at 12, 24, and 36 months was 96.2%, 90.1%, and 79.5%, respectively. TP53 disruption was associated with an increased risk of death (P = 0.01). Data on 162 patients ≥65 years treated with ibrutinib were analyzed and compared with 165 patients ≥65 years treated with BR. Factors predicting for a longer PFS at multivariable analysis in the total patient population treated with BR and ibrutinib were age (HR 1.06, 95% CI 1.02‐1.10, P < 0.01) and treatment with ibrutinib (HR 0.55, 95% CI 0.33‐0.93, P = 0.03). In a post hoc analysis of patients in advanced stage, a significant PFS advantage was observed in patient who had received ibrutinib (P = 0.03), who showed a trend for OS advantage (P = 0.08). We arrived at the following conclusions: (a) BR is a relatively effective first‐line regimen in a real‐world population of unfit patients without TP53 disruption, (b) ibrutinib provided longer disease control than BR in patients with advanced disease stage.
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Affiliation(s)
- Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Anthony R Mato
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Massimo Gentile
- Department of Onco-Hematology, Hematology Unit, A.O. of Cosenza, Cosenza, Italy
| | - Luca Laurenti
- Department of Radiological, Radiotherapeutic and Hematological Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison Winter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Constantine S Tam
- Peter McCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Alan P Skarbnik
- Lymphoproliferative Disorders Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Jeffrey J Pu
- SUNY Upstate Medical University, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Stephen J Schuster
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chaitra S Ujjani
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Lindsey Roeker
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Atto Billio
- Hematology and Transplant Unit, San Maurizio Hospital, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Martin Spacek
- Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of eastern Piedmont, Novara, Italy
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucia Farina
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Stefano Molica
- Hematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | | | | | - Isacco Ferrarini
- Hematology, Department of Cell Therapy and Hematology, University Hospital, Verona, Italy
| | - Giuseppe Cimino
- Department of Translational and Precision Medicine, University "La Sapienza", UOC di Ematologia con Trapianto, Ospedale S. Maria Goretti, Latina, Italy
| | - Maurizio Cavallari
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Rosalba Cucci
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Paolo Ghia
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
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17
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Mato AR, Roeker LE, Jacobs R, Hill BT, Lamanna N, Brander D, Shadman M, Ujjani CS, Yazdy MS, Perini GF, Pinilla-Ibarz JA, Barrientos J, Skarbnik AP, Torka P, Pu JJ, Pagel JM, Gohil S, Fakhri B, Choi M, Coombs CC, Rhodes J, Barr PM, Portell CA, Parry H, Garcia CA, Whitaker KJ, Winter AM, Sitlinger A, Khajavian S, Grajales-Cruz AF, Isaac KM, Shah P, Akhtar OS, Pocock R, Lam K, Voorhees TJ, Schuster SJ, Rodgers TD, Fox CP, Martinez-Calle N, Munir T, Bhavsar EB, Bailey N, Lee JC, Weissbrot HB, Nabhan C, Goodfriend JM, King AC, Zelenetz AD, Dorsey C, Bigelow K, Cheson BD, Allan JN, Eyre TA. Assessment of the Efficacy of Therapies Following Venetoclax Discontinuation in CLL Reveals BTK Inhibition as an Effective Strategy. Clin Cancer Res 2020; 26:3589-3596. [PMID: 32198151 PMCID: PMC8588795 DOI: 10.1158/1078-0432.ccr-19-3815] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Venetoclax-based therapy is a standard-of-care option in first-line and relapsed/refractory chronic lymphocytic leukemia (CLL). Patient management following venetoclax discontinuation remains nonstandard and poorly understood. EXPERIMENTAL DESIGN To address this, we conducted a large international study to identify a cohort of 326 patients who discontinued venetoclax and have been subsequently treated. Coprimary endpoints were overall response rate (ORR) and progression-free survival for the post-venetoclax treatments stratified by treatment type [Bruton's tyrosine kinase inhibitor (BTKi), PI3K inhibitor (PI3Ki), and cellular therapies]. RESULTS We identified patients with CLL who discontinued venetoclax in the first-line (4%) and relapsed/refractory settings (96%). Patients received a median of three therapies prior to venetoclax; 40% were BTKi naïve (n = 130), and 81% were idelalisib naïve (n = 263). ORR to BTKi was 84% (n = 44) in BTKi-naïve patients versus 54% (n = 30) in BTKi-exposed patients. We demonstrate therapy selection following venetoclax requires prior novel agent exposure consideration and discontinuation reasons. CONCLUSIONS For BTKi-naïve patients, selection of covalently binding BTKis results in high ORR and durable remissions. For BTKi-exposed patients, covalent BTK inhibition is not effective in the setting of BTKi resistance. PI3Kis following venetoclax do not appear to result in durable remissions. We conclude that BTKi in naïve or previously responsive patients and cellular therapies following venetoclax may be the most effective strategies.See related commentary by Rogers, p. 3501.
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Affiliation(s)
- Anthony R Mato
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | | | - Ryan Jacobs
- Department of Hematology, Lymphoma Division, Levine Cancer Institute, Charlotte, North Carolina
| | - Brian T Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicole Lamanna
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chaitra S Ujjani
- Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Maryam Sarraf Yazdy
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | | | | | | | | | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Jeffrey J Pu
- SUNY Upstate Medical University, Syracuse, New York
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Satyen Gohil
- University College London, London, United Kingdom
| | - Bita Fakhri
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California
| | - Michael Choi
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Catherine C Coombs
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Joanna Rhodes
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul M Barr
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Craig A Portell
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | - Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Christine A Garcia
- Hillman Cancer Pavilion, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Allison M Winter
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
| | | | | | - Krista M Isaac
- Division of Hematology and Oncology, University of Virginia, Charlottesville, Virginia
| | | | | | | | - Kentson Lam
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Timothy J Voorhees
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen J Schuster
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher P Fox
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Nicolas Martinez-Calle
- Clinical Haematology Department, Nottingham University Hospitals NHS Trust, Nottingham, England, United Kingdom
| | - Talha Munir
- Weill Cornell Medicine, Long Island City, New York
| | - Erica B Bhavsar
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, Washington
| | - Jason C Lee
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | - Hanna B Weissbrot
- Herbert Irving Comprehensive Cancer Center (New York-Presbyterian Columbia University Medical Center), New York, New York
| | | | | | - Amber C King
- Clinical Pharmacy Specialist-Leukemia, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Zelenetz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen Dorsey
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kayla Bigelow
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington D.C
| | - John N Allan
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Toby A Eyre
- Department of Haematology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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18
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Regan S, Yang X, Finnberg NK, El-Deiry WS, Pu JJ. Occurrence of acute myeloid leukemia in hydroxyurea-treated sickle cell disease patient. Cancer Biol Ther 2019; 20:1389-1397. [PMID: 31423878 DOI: 10.1080/15384047.2019.1647055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Hydroxyurea (HU) has been widely used in sickle cell disease. Its potential long-term risk for carcinogenesis or leukemogenic risk remains undefined. Here, we report a 26 y old African-American female with Sickle Cell Disease (SCD) who developed refractory/relapsed acute myeloid leukemia (AML) 6 months after 26 months of HU use. That patient's cytogenetics and molecular genetics analyses demonstrated a complex mutation profile with 5q deletion, trisomy 8, and P53 deletion (deletion of 17p13.1). P53 gene sequence studies revealed a multitude of somatic mutations that most suggest a treatment-related etiology. The above-mentioned data indicates that the patient may have developed acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) as a direct result of HU exposure.
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Affiliation(s)
- Samuel Regan
- Department of Medicine, College of Medicine, SUNY Upstate Medical University , Syracuse , New York , USA
| | - Xuebin Yang
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
| | | | - Wafik S El-Deiry
- Department of Pathology, Warren Alpert Medical School, Brown University , Providence , Rhode Island , USA
| | - Jeffrey J Pu
- Department of Medicine, College of Medicine, SUNY Upstate Medical University , Syracuse , New York , USA.,Upstate Cancer Center, Departments of Medicine, Pathology, and Pharmacology, SUNY Upstate Medical University , Syracuse , New York , USA.,Syracuse VA Medical Center, SUNY Upstate Medical University , Syracuse , New York , USA
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19
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Pu JJ, Poulose J, Malysz J, Zhu J, Fanburg-Smith JC, Claxton DF, Bayerl MG. Impact of ruxolitinib on myelofibrosis patients post allogeneic stem cell transplant-a pilot study. Br J Haematol 2019; 186:e130-e133. [PMID: 31115038 DOI: 10.1111/bjh.15967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jeffrey J Pu
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA.,Departments of Medicine, Pathology, and Pharmacology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY, USA.,Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Joyson Poulose
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - Jozef Malysz
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - Junjia Zhu
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - Julie C Fanburg-Smith
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - David F Claxton
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - Michael G Bayerl
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA, USA
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20
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Pu JJ, Poulose J, Zhu J, Malysz J, Fanburg-Smith J, Bayerl M. Ruxolitinib Maintenance Post Myelofibrosis Allogeneic Stem Cell Transplant. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Mato AR, Roeker LE, Allan JN, Pagel JM, Brander DM, Hill BT, Cheson BD, Furman RR, Lamanna N, Tam CS, Handunnetti S, Jacobs R, Lansigan F, Bhavsar E, Barr PM, Shadman M, Skarbnik AP, Goy A, Beach DF, Svoboda J, Pu JJ, Sehgal AR, Zent CS, Tuncer HH, Schuster SJ, Pickens PV, Shah NN, Rhodes J, Ujjani CS, Nabhan C. Outcomes of front-line ibrutinib treated CLL patients excluded from landmark clinical trial. Am J Hematol 2018; 93:1394-1401. [PMID: 30132965 DOI: 10.1002/ajh.25261] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022]
Abstract
Ibrutinib demonstrated superior response rates and survival for treatment-naïve chronic lymphocytic leukemia (CLL) patients in a pivotal study that excluded patients younger than 65 (<65) and/or with chromosome 17p13 deletion (del[17p13]). We examined outcomes and toxicities of CLL patients who would have been excluded from the pivotal study, specifically <65 and/or those with del[17p13]. This multicenter, retrospective cohort study examined CLL patients treated with front-line ibrutinib at 20 community and academic centers, categorizing them based on key inclusion criteria for the RESONATE-2 trial: <65 vs ≥65 and present vs absent del[17p13]. Of 391 included patients, 57% would have been excluded from the pivotal study. Forty-one percent of our cohort was <65, and 30% had del(17p13). Patients <65 were more likely to start 420 mg of ibrutinib daily; those who started at reduced doses had inferior PFS. The most common adverse events were arthralgias, fatigue, rash, bruising, and diarrhea. Twenty-four percent discontinued ibrutinib at 13.8 months median follow-up; toxicity was the most common reason for discontinuation, though progression and/or transformation accounted for a larger proportion of discontinuations in <65 and those with del(17p13). Response rates were similar for <65 and those with del(17p13). However, patients with del(17p13) had inferior PFS and OS. Ibrutinib in the front-line setting has extended beyond the population in which it was initially studied and approved. This study highlights and compares important differences in ibrutinib dosing, treatment interruptions, toxicities, reasons for discontinuation, and survival outcomes in two important patient populations not studied in RESONATE-2.
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Affiliation(s)
- Anthony R. Mato
- CLL Program, Division of Hematological Oncology; Memorial Sloan Kettering Cancer Center; New York New York
| | - Lindsey E. Roeker
- CLL Program, Division of Hematological Oncology; Memorial Sloan Kettering Cancer Center; New York New York
| | - John N. Allan
- New York Presbyterian & Weill Cornell; New York New York
| | - John M. Pagel
- Center for Blood Disorders and Stem Cell Transplantation; Swedish Cancer Institute; Seattle Western Australia
| | - Danielle M. Brander
- Division of Hematologic Malignancies and Cellular Therapy; Duke University; Durham North Carolina
| | - Brian T. Hill
- Taussig Cancer Institute; Cleveland Clinic; Cleveland Ohio
| | - Bruce D. Cheson
- Lombardi Comprehensive Cancer Center; Georgetown University Hospital; Washington District of Columbia
| | | | | | - Constantine S. Tam
- Peter McCallum Cancer Centre; University of Melbourne; East Melbourne VI Australia
| | - Sasanka Handunnetti
- Peter McCallum Cancer Centre; University of Melbourne; East Melbourne VI Australia
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders; Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | | | - Erica Bhavsar
- New York Presbyterian & Weill Cornell; New York New York
| | - Paul M. Barr
- Wilmot Cancer Institute; University of Rochester Medical Center; Rochester New York
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center; Seattle Cancer Care Alliance; Seattle Western Australia
| | - Alan P. Skarbnik
- John Theurer Cancer Center; Hackensack University Medical Center; Hackensack New Jersey
| | - Andre Goy
- John Theurer Cancer Center; Hackensack University Medical Center; Hackensack New Jersey
| | - Douglas F. Beach
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Jakub Svoboda
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | | | | | - Clive S. Zent
- Wilmot Cancer Institute; University of Rochester Medical Center; Rochester New York
| | | | - Stephen J. Schuster
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Peter V. Pickens
- Abington Hematology/Oncology Associates Inc.; Willow Grove Pennsylvania
| | - Nirav N. Shah
- Division of Hematology & Oncology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Joanna Rhodes
- Division of Hematology and Oncology; University of Pennsylvania; Philadelphia Pennsylvania
| | - Chaitra S. Ujjani
- Lombardi Comprehensive Cancer Center; Georgetown University Hospital; Washington District of Columbia
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22
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Mato AR, Thompson M, Allan JN, Brander DM, Pagel JM, Ujjani CS, Hill BT, Lamanna N, Lansigan F, Jacobs R, Shadman M, Skarbnik AP, Pu JJ, Barr PM, Sehgal AR, Cheson BD, Zent CS, Tuncer HH, Schuster SJ, Pickens PV, Shah NN, Goy A, Winter AM, Garcia C, Kennard K, Isaac K, Dorsey C, Gashonia LM, Singavi AK, Roeker LE, Zelenetz A, Williams A, Howlett C, Weissbrot H, Ali N, Khajavian S, Sitlinger A, Tranchito E, Rhodes J, Felsenfeld J, Bailey N, Patel B, Burns TF, Yacur M, Malhotra M, Svoboda J, Furman RR, Nabhan C. Real-world outcomes and management strategies for venetoclax-treated chronic lymphocytic leukemia patients in the United States. Haematologica 2018; 103:1511-1517. [PMID: 29880613 PMCID: PMC6119152 DOI: 10.3324/haematol.2018.193615] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 11/09/2022] Open
Abstract
Venetoclax is a BCL2 inhibitor approved for 17p-deleted relapsed/refractory chronic lymphocytic leukemia with activity following kinase inhibitors. We conducted a multicenter retrospective cohort analysis of patients with chronic lymphocytic leukemia treated with venetoclax to describe outcomes, toxicities, and treatment selection following venetoclax discontinuation. A total of 141 chronic lymphocytic leukemia patients were included (98% relapsed/refractory). Median age at venetoclax initiation was 67 years (range 37-91), median prior therapies was 3 (0-11), 81% unmutated IGHV, 45% del(17p), and 26.8% complex karyotype (≥ 3 abnormalities). Prior to venetoclax initiation, 89% received a B-cell receptor antagonist. For tumor lysis syndrome prophylaxis, 93% received allopurinol, 92% normal saline, and 45% rasburicase. Dose escalation to the maximum recommended dose of 400 mg daily was achieved in 85% of patients. Adverse events of interest included neutropenia in 47.4%, thrombocytopenia in 36%, tumor lysis syndrome in 13.4%, neutropenic fever in 11.6%, and diarrhea in 7.3%. The overall response rate to venetoclax was 72% (19.4% complete remission). With a median follow up of 7 months, median progression free survival and overall survival for the entire cohort have not been reached. To date, 41 venetoclax treated patients have discontinued therapy and 24 have received a subsequent therapy, most commonly ibrutinib. In the largest clinical experience of venetoclax-treated chronic lymphocytic leukemia patients, the majority successfully completed and maintained a maximum recommended dose. Response rates and duration of response appear comparable to clinical trial data. Venetoclax was active in patients with mutations known to confer ibrutinib resistance. Optimal sequencing of newer chronic lymphocytic leukemia therapies requires further study.
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Affiliation(s)
- Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meghan Thompson
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Chaitra S Ujjani
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic Foundation, OH, USA
| | | | | | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Mazyar Shadman
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA, USA
| | - Alan P Skarbnik
- John Theurer Cancer Center, Hackensack Meridian Health, NJ, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | - Bruce D Cheson
- Georgetown University Hospital Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Clive S Zent
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | - Stephen J Schuster
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI, USA
| | - Andre Goy
- John Theurer Cancer Center, Hackensack Meridian Health, NJ, USA
| | | | | | - Kaitlin Kennard
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Krista Isaac
- Internal Medicine, Lankenau Medical Center, Wynnewood, PA, USA
| | - Colleen Dorsey
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M Gashonia
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arun K Singavi
- Division of Hematology & Oncology, Medical College of Wisconsin, Brookfield, WI, USA
| | - Lindsey E Roeker
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Zelenetz
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Department of Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annalynn Williams
- Wilmot Cancer Institute Division of Hematology/Oncology, University of Rochester Medical Center, NY, USA
| | | | | | - Naveed Ali
- Abington Hem. Onc. Assoc., Inc., Willow Grove, PA, USA
| | - Sirin Khajavian
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, WA, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Eve Tranchito
- Taussig Cancer Institute, Cleveland Clinic Foundation, OH, USA
| | - Joanna Rhodes
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Neil Bailey
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | | | | | | | | | - Jakub Svoboda
- Center for CLL, Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
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23
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Mato AR, Schuster SJ, Lamanna N, Flinn I, Barrientos JC, Kambhampati S, Cheson BD, Barr PM, Pagel JM, Reeves JA, Lansigan F, Pu JJ, Skarbnik AP, Fonseca GA, Dorsey C, Luning Prak E, Paskalis D, Sportelli P, Miskin HP, Brander DM. A phase 2 study to assess the safety and efficacy of umbralisib (TGR-1202) in pts with CLL who are intolerant to prior BTK or PI3Kδ inhibitor therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Nicole Lamanna
- New York-Presbyterian, Columbia University Medical Center, Manhasset, NY
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN
| | | | - Suman Kambhampati
- Sarah Cannon Research Institute at Research Medical Center, Kansas City, MO
| | - Bruce D. Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | - Paul M. Barr
- University of Rochester Medical Center, Rochester, NY
| | | | - James Andrew Reeves
- Florida Cancer Specialists South / Sarah Cannon Research Institute, Ft Myers, FL
| | | | | | | | - Gustavo A. Fonseca
- Florida Cancer Specialists/Sarah Cannon Research Institute, St. Petersburg, FL
| | - Colleen Dorsey
- Memorial Sloan Kettering Cancer Center / CLL Program, Leukemia Service, New York, NY
| | - Eline Luning Prak
- Clinical Immunology Laboratory at the Hospital of the University of Pennsylvania, Philadelphia, PA
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24
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Poulose J, Pu JJ, Malysz J, Bayerl M, Fanburg-Smith J, Hohl RJ, Mineishi S, Zhu J. Impact of ruxolitinib in myelofibrosis post allogeneic stem cell transplant: A pilot study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jeffrey J. Pu
- State University of New York Upstate Cancer Center, Syracuse, NY
| | - Jozef Malysz
- Penn State Hershey Cancer Institute, Hershey, PA
| | | | | | | | | | - Junjia Zhu
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
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25
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Gay LM, Fabrizio D, Frampton GM, Albacker LA, Sokol E, Elvin JA, Vergilio JA, Suh J, Ramkissoon SH, Severson EA, Daniel S, Ali SM, Chung J, Schrock AB, Miller VA, Pu JJ, Corona RJ, Bratslavsky G, Ross JS. PD-L1 genomic alterations (GA) in solid tumors and hematologic malignancies: A comprehensive genomic profiling (CGP) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - James Suh
- Foundation Medicine, Inc., Cambridge, MA
| | | | | | | | | | - Jon Chung
- Foundation Medicine, Inc., Cambridge, MA
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26
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Teye EK, Sido A, Xin P, Finnberg NK, Gokare P, Kawasawa YI, Salzberg AC, Shimko S, Bayerl M, Ehmann WC, Claxton DF, Rybka WB, Drabick JJ, Wang HG, Abraham T, El-Deiry WS, Brodsky RA, J Hohl R, Pu JJ. PIGN gene expression aberration is associated with genomic instability and leukemic progression in acute myeloid leukemia with myelodysplastic features. Oncotarget 2018; 8:29887-29905. [PMID: 28187452 PMCID: PMC5444711 DOI: 10.18632/oncotarget.15136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022] Open
Abstract
Previous studies have linked increased frequency of glycosylphosphatidylinositol-anchor protein (GPI-AP) deficiency with genomic instability and the risk of carcinogenesis. However, the underlying mechanism is still not clear. A randomForest analysis of the gene expression array data from 55 MDS patients (GSE4619) demonstrated a significant (p = 0.0007) correlation (Pearson r =-0.4068) between GPI-anchor biosynthesis gene expression and genomic instability, in which PIGN, a gene participating in GPI-AP biosynthesis, was ranked as the third most important in predicting risk of MDS progression. Furthermore, we observed that PIGN gene expression aberrations (increased transcriptional activity but diminished to no protein production) were associated with increased frequency of GPI-AP deficiency in leukemic cells during leukemic transformation/progression. PIGN gene expression aberrations were attributed to partial intron retentions between exons 14 and 15 resulting in frameshifts and premature termination which were confirmed by examining the RNA-seq data from a group of AML patients (phs001027.v1.p1). PIGN gene expression aberration correlated with the elevation of genomic instability marker expression that was independent of the TP53 regulatory pathway. Suppression/elimination of PIGN protein expression caused a similar pattern of genomic instability that was rescued by PIGN restoration. Finally, we found that PIGN bound to the spindle assembly checkpoint protein, MAD1, and regulated its expression during the cell cycle. In conclusion, PIGN gene is crucial in regulating mitotic integrity to maintain chromosomal stability and prevents leukemic transformation/progression.
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Affiliation(s)
- Emmanuel K Teye
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Abigail Sido
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Ping Xin
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Niklas K Finnberg
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Prashanth Gokare
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Yuka I Kawasawa
- Institute for Personalized Medicine and Departments of Pharmacology, Biochemistry and Molecular Biology, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Anna C Salzberg
- Institute for Personalized Medicine and Departments of Pharmacology, Biochemistry and Molecular Biology, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sara Shimko
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Michael Bayerl
- Department of Pathology, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - W Christopher Ehmann
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - David F Claxton
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Witold B Rybka
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA.,Department of Pathology, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Joseph J Drabick
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Hong-Gang Wang
- Department of Pediatrics, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Thomas Abraham
- Department of Neural and Behavioral Science and the Microscopy Imaging Facility, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Wafik S El-Deiry
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Robert A Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymond J Hohl
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Jeffrey J Pu
- Penn State Hershey Cancer Institute and Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA.,Department of Pathology, Penn State University College of Medicine, Hershey, Pennsylvania, USA
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27
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Mato AR, Hill BT, Lamanna N, Barr PM, Ujjani CS, Brander DM, Howlett C, Skarbnik AP, Cheson BD, Zent CS, Pu JJ, Kiselev P, Foon K, Lenhart J, Henick Bachow S, Winter AM, Cruz AL, Claxton DF, Goy A, Daniel C, Isaac K, Kennard KH, Timlin C, Fanning M, Gashonia L, Yacur M, Svoboda J, Schuster SJ, Nabhan C. Optimal sequencing of ibrutinib, idelalisib, and venetoclax in chronic lymphocytic leukemia: results from a multicenter study of 683 patients. Ann Oncol 2018; 28:1050-1056. [PMID: 28453705 DOI: 10.1093/annonc/mdx031] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Ibrutinib, idelalisib, and venetoclax are approved for treating CLL patients in the United States. However, there is no guidance as to their optimal sequence. Patients and methods We conducted a multicenter, retrospective analysis of CLL patients treated with kinase inhibitors (KIs) or venetoclax. We examined demographics, discontinuation reasons, overall response rates (ORR), survival, and post-KI salvage strategies. Primary endpoint was progression-free survival (PFS). Results A total of 683 patients were identified. Baseline characteristics were similar in the ibrutinib and idelalisib groups. ORR to ibrutinib and idelalisib as first KI was 69% and 81%, respectively. With a median follow-up of 17 months (range 1-60), median PFS and OS for the entire cohort were 35 months and not reached. Patients treated with ibrutinib (versus idelalisib) as first KI had a significantly better PFS in all settings; front-line [hazard ratios (HR) 2.8, CI 1.3-6.3, P = 0.01], relapsed-refractory (HR 2.8, CI 1.9-4.1, P < 0.001), del17p (HR 2.0, CI 1.2-3.4, P = 0.008), and complex karyotype (HR 2.5, CI 1.2-5.2, P = 0.02). At the time of initial KI failure, use of an alternate KI or venetoclax had a superior PFS when compared with chemoimmunotherapy. Furthermore, patients who discontinued ibrutinib due to progression or toxicity had marginally improved outcomes if they received venetoclax (ORR 79%) versus idelalisib (ORR 46%) (PFS HR .6, CI.3-1.0, P = 0.06). Conclusions In the largest real-world experience of novel agents in CLL, ibrutinib appears superior to idelalisib as first KI. Furthermore, in the setting of KI failure, alternate KI or venetoclax therapy appear superior to chemoimmunotherapy combinations. The use of venetoclax upon ibrutinib failure might be superior to idelalisib. These data support the need for trials testing sequencing strategies to optimize treatment algorithms.
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Affiliation(s)
- A R Mato
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - B T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA
| | - N Lamanna
- Division of Hematology and Oncology, New York Presbyterian/Columbia University Medical Center, New York, USA
| | - P M Barr
- Wilmot Cancer Institute, University of Rochester, Rochester, USA
| | - C S Ujjani
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, USA
| | | | - C Howlett
- Department of Pharmacy and Clinical Services, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, USA.,Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, USA
| | - A P Skarbnik
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, USA
| | - B D Cheson
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, USA
| | - C S Zent
- Wilmot Cancer Institute, University of Rochester, Rochester, USA
| | - J J Pu
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, USA
| | | | - K Foon
- Celgene Corporation, Summit, USA
| | | | - S Henick Bachow
- Division of Hematology and Oncology, New York Presbyterian/Columbia University Medical Center, New York, USA
| | - A M Winter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA
| | - A-L Cruz
- Medstar Washington Hospital Center, Washington, USA
| | - D F Claxton
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, USA
| | - A Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, USA
| | - C Daniel
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - K Isaac
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - K H Kennard
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - C Timlin
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - M Fanning
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - L Gashonia
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - M Yacur
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, USA
| | - J Svoboda
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - S J Schuster
- Center for CLL, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - C Nabhan
- Cardinal Health Specialty Solutions, Waukegan, USA
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Prabhu VV, Talekar MK, Lulla AR, Kline CLB, Zhou L, Hall J, Van den Heuvel APJ, Dicker DT, Babar J, Grupp SA, Garnett MJ, McDermott U, Benes CH, Pu JJ, Claxton DF, Khan N, Oster W, Allen JE, El-Deiry WS. Single agent and synergistic combinatorial efficacy of first-in-class small molecule imipridone ONC201 in hematological malignancies. Cell Cycle 2018; 17:468-478. [PMID: 29157092 DOI: 10.1080/15384101.2017.1403689] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
ONC201, founding member of the imipridone class of small molecules, is currently being evaluated in advancer cancer clinical trials. We explored single agent and combinatorial efficacy of ONC201 in preclinical models of hematological malignancies. ONC201 demonstrated (GI50 1-8 µM) dose- and time-dependent efficacy in acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), chronic lymphocytic leukemia (CLL), diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), Burkitt's lymphoma, anaplastic large cell lymphoma (ALCL), cutaneous T-cell lymphoma (CTCL), Hodgkin's lymphoma (nodular sclerosis) and multiple myeloma (MM) cell lines including cells resistant to standard of care (dexamethasone in MM) and primary samples. ONC201 induced caspase-dependent apoptosis that involved activation of the integrated stress response (ATF4/CHOP) pathway, inhibition of Akt phosphorylation, Foxo3a activation, downregulation of cyclin D1, IAP and Bcl-2 family members. ONC201 synergistically reduced cell viability in combination with cytarabine and 5-azacytidine in AML cells. ONC201 combined with cytarabine in a Burkitt's lymphoma xenograft model induced tumor growth inhibition that was superior to either agent alone. ONC201 synergistically combined with bortezomib in MM, MCL and ALCL cells and with ixazomib or dexamethasone in MM cells. ONC201 combined with bortezomib in a Burkitt's lymphoma xenograft model reduced tumor cell density and improved CHOP induction compared to either agent alone. These results serve as a rationale for ONC201 single-agent trials in relapsed/refractory acute leukemia, non-Hodgkin's lymphoma, MM and combination trial with dexamethasone in MM, provide pharmacodynamic biomarkers and identify further synergistic combinatorial regimens that can be explored in the clinic.
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Affiliation(s)
| | - Mala K Talekar
- b The Children's Hospital of Philadelphia , Philadelphia , PA
| | | | | | - Lanlan Zhou
- c Fox Chase Cancer Center , Philadelphia , PA
| | - Junior Hall
- b The Children's Hospital of Philadelphia , Philadelphia , PA
| | | | | | - Jawad Babar
- c Fox Chase Cancer Center , Philadelphia , PA
| | - Stephan A Grupp
- b The Children's Hospital of Philadelphia , Philadelphia , PA
| | | | | | - Cyril H Benes
- f Massachusetts General Hospital, Harvard Medical School , Boston , MA
| | | | | | - Nadia Khan
- c Fox Chase Cancer Center , Philadelphia , PA
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Pu JJ, Teye EK, Sido A, Kawasawa YI, Xin P, Finnberg NK, El-Deiry WS, Shimko S. Abstract 5713: PIGN gene expression aberration weakens chromosomal stability via altering its interaction with the spindle assembly checkpoint protein complex during leukemogenesis. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Previous studies have linked increased frequency of glycosylphosphatidylinositol-anchor protein (GPI-AP) deficiency with genomic instability and the risk of carcinogenesis. Recently, Phosphatidylinositol Glycan Anchor Biosynthesis; Class N (PIGN), a gene participating in GPI-AP synthesis, was suggested as a cancer chromosomal instability suppressor in a colon cancer model. We investigated the association of PIGN with genomic instability and leukemogenesis. A Random Forest analysis of the gene expression array data from 55 MDS patients (GSE4619) demonstrated a significant (p = 0.0007) correlation (Pearson r =-0.4068) between GPI-anchor biosynthesis gene expression and genomic instability, in which PIGN was ranked as the third most important in predicting risk of MDS progression. We observed that PIGN gene expression aberrations (increased transcriptional activity but diminished to no protein production) were associated with increased frequency of GPI-AP deficiency in leukemic cells during leukemic transformation/progression. The PIGN gene expression aberrations were attributed to partial intron retentions between exons 14 and 15 resulting in frameshifts and premature termination which were confirmed by examining the RNA-seq data from a group of AML patients (phs001027.v1.p1). PIGN gene expression aberration correlated with the elevation of genomic instability marker expression that was independent of the TP53 regulatory pathway. PIGN protein expression suppression/elimination caused a similar pattern of genomic instability that was rescued by PIGN restoration. Furthermore, PIGN bound to the spindle assembly checkpoint proteins and regulated their expression during the cell cycle. In conclusion, PIGN gene is crucial in the regulation of mitotic integrity to maintain chromosomal stability and prevents leukemic transformation/progression.
Citation Format: Jeffrey J. Pu, Emmanuel K. Teye, Abigail Sido, Yuka I. Kawasawa, Ping Xin, Niklas K. Finnberg, Wafik S. El-Deiry, Sara Shimko. PIGN gene expression aberration weakens chromosomal stability via altering its interaction with the spindle assembly checkpoint protein complex during leukemogenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5713. doi:10.1158/1538-7445.AM2017-5713
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Affiliation(s)
| | | | - Abigail Sido
- 1Penn State Hershey Cancer Institute, Hershey, PA
| | | | - Ping Xin
- 1Penn State Hershey Cancer Institute, Hershey, PA
| | | | | | - Sara Shimko
- 1Penn State Hershey Cancer Institute, Hershey, PA
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Dorsey C, Paskalis D, Brander DM, Lansigan F, Barr PM, Lamanna N, Cheson BD, Pu JJ, Schreeder MT, Pagel JM, Sportelli P, Fanning MJ, Miskin HP, Zimmer T, Walsh K, Schuster SJ, Luning-Prak ET, Wileyto EP, Weiss MS, Mato AR. KI intolerance study: A phase 2 study to assess the safety and efficacy of TGR-1202 in pts with chronic lymphocytic leukemia (CLL) who are intolerant to prior BTK or PI3K-delta inhibitor therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps7569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS7569 Background: Although kinase inhibitor (KI) therapies, such as ibrutinib, are generally well tolerated, intolerance is the most common reason for discontinuation (d/c) in practice (~50%, Mato et al, Blood 2016). Additionally KI interruptions (≥ 8 days) can shorten OS (Barr et al, ASCO 2015). Fortunately, data suggest that KIs have non-overlapping toxicity profiles. Therefore, pts who d/c KI due to intolerance, with ongoing CLL response, represent an unmet need. TGR-1202 is a next generation, highly-specific PI3K-delta inhibitor with nanomolar inhibitory potency. TGR-1202 is well-tolerated with a d/c rate due to AEs of 8% as demonstrated in an integrated safety analysis of 165 treated pts (Burris et al, ASCO 2016). Methods: A phase 2 investigator initiated study is being conducted to assess the safety and activity of TGR-1202 in CLL pts who are KI intolerant. KI Intolerance is defined as ≥ 1 Gr 3 or ≥ 2 Gr 2 non-heme toxicities, ≥ 1 Gr 3 neutropenia with infection or fever, and/or ≥ 1 Gr 4 heme toxicity leading to KI (BTK and/or PI3K inhibitor) d/c (Table). Toxicities must resolve to ≤ Gr 1 prior to TGR-1202 dosing. Prior KI must be d/c for ≥ 14 days without progression (PD). All eligible pts are treated with TGR-1202 (800mg oral daily) until PD, toxicity or study conclusion. Primary study endpoint is PFS. Secondary endpoints include ORR, duration of response, time to treatment failure and TGR-1202 safety profile. Peripheral blood samples are collected prior to TGR-1202, after 28 days and at PD for correlative analyses to identify markers associated with KI intolerance. The trial commenced 10/1/2016. 55 eligible pts will be enrolled in approximately 12 months with 24 months follow-up. As of 1/2017, 10 study sites are enrolling pts with 10 more to be activated. To date, 10 pts have been enrolled and treated with TGR-1202. Clinical trial information: NCT02742090. [Table: see text]
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Affiliation(s)
| | | | | | | | - Paul M. Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Nicole Lamanna
- New York-Presbyterian, Columbia University Medical Center, Manhasset, NY
| | - Bruce D. Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | | | | | | | | | | | | | - Tracey Zimmer
- Abfamson Cancer Center of the Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Anthony R. Mato
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Abstract
Primary myelofibrosis is a unique entity among BCR-ABL-negative myeloproliferative diseases, manifesting as bone marrow fibrosis and pancytopenia. Considerable evidence indicates that genetic and epigenetic abnormalities can result in defective clonal hematopoietic stem cell proliferation in addition to bone marrow microenvironment alteration. The "bad seeds in bad soil" theory illustrates the orchestrating efforts of hematopoietic stem cells, stromal cells, and their surrounding signaling molecules in myelofibrosis progression and malignancy transformation, though the exact mechanism of myelofibrosis is still not clear. This study reviews current concepts and questions regarding the pathogenesis of primary myelofibrosis and discusses the emerging targeted therapy aimed at restoring normal bone marrow environment and halting bone marrow fibrotic deterioration.
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Affiliation(s)
- Lindsey Shantzer
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kristin Berger
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA
| | - Jeffrey J Pu
- Department of Medicine, Penn State University College of Medicine, Hershey, PA, USA. .,Department of Pathology, Pennsylvania State University College of Medicine, Hershey, PA, USA. .,Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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32
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Pu JJ, Miller EL, Davis C, Berg AS, Comito M, Greiner RJ, Ehmann WC, Claxton DF, Rybka W. Unrelated Donor Umbilical Cord Blood Transplantation with and without Total Body Irradiation: A Single-Center Experience. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sun XS, Liu X, Xu KL, Chen A, Rybka WB, Pu JJ. Advances and perspectives on cellular therapy in acquired bone marrow failure diseases. World J Hematol 2016; 5:31-36. [DOI: 10.5315/wjh.v5.i1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/24/2015] [Accepted: 01/07/2016] [Indexed: 02/05/2023] Open
Abstract
Acquired bone marrow failure diseases (ABMFD) are a class of hematopoietic stem cell diseases with a commonality of non-inherited disruption of hematopoiesis that results in pancytopenia. ABMFDs also are a group of heterogeneous diseases with different etiologies and treatment options. The three most common ABMFDs are aplastic anemia, myelodysplastic syndrome, and paroxysmal nocturnal hemoglobinuria. Stem cell transplantation is the only treatment that can cure these diseases. However, due to high therapy-related mortality, stem cell transplantation has rarely been used as a first line treatment in treating ABMFD. With the advance of personalized medicine and precision medicine, various novel cellular therapy strategies are in trial to increase the efficiency and efficacy of ABMFD treatment. This article aims to review current available stem cell transplantation protocols and promising cellular therapy research in treating ABMFD.
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Chepovetsky J, Duffield AS, Pu JJ. Paraneoplastic cerebellar degeneration as an early sign of classical Hodgkin lymphoma. Ann Hematol 2015; 95:511-3. [DOI: 10.1007/s00277-015-2542-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 10/23/2015] [Indexed: 11/24/2022]
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35
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Pu JJ, Miller EL, Davis C, Berg AS, Comito M, Greiner R, Ehmann WC, Claxton D, Rybka WB. Unrelated donor umbilical cord blood transplantation with and without total body irradiation: A single-center experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e18001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - David Claxton
- Penn State Milton S. Hershey Medical Center, Hershey, PA
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36
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Lu Y, Qi YX, Zhang H, Zhang HQ, Pu JJ, Xie YX. Separation and identification of Musa acuminate Colla (banana) leaf proteins by two-dimensional gel electrophoresis and mass spectrometry. Genet Mol Res 2013; 12:6871-81. [PMID: 24391035 DOI: 10.4238/2013.december.19.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
To establish a proteomic reference map of Musa acuminate Colla (banana) leaf, we separated and identified leaf proteins using two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) and mass spectrometry (MS). Tryptic digests of 44 spots were subjected to peptide mass fingerprinting (PMF) by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) MS. Three spots that were not identified by MALDI-TOF MS analysis were identified by searching against the NCBInr, SwissProt, and expressed sequence tag (EST) databases. We identified 41 unique proteins. The majority of the identified leaf proteins were found to be involved in energy metabolism. The results indicate that 2D-PAGE is a sensitive and powerful technique for the separation and identification of Musa leaf proteins. A summary of the identified proteins and their putative functions is discussed.
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Affiliation(s)
- Y Lu
- Environment and Plant Protection Institute, Chinese Academy of Tropical Agricultural Sciences, Hainan, China
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37
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Pu JJ, Spivak JL, Brodsky RA, Moliterno A. The origin of GPI-AP deficient cells in MDS, MPD, and aplastic anemia and its significance in predicting leukemic transformation. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7032 Background: PNH is a clonal disorder originating from a multipotent hematopoietic stem cell (HSC) acquiring a PIG-A gene mutation. PIG-A mutation lead to glycosylphosphatidylinositol-anchor protein (GPI-AP) deficiency, which contributes to many manifestations of PNH. About 25% of MDS and MPD, and 60% of AA also harbor small population of PNH-like cells. It was observed that 1) 10-20% AA harboring PNH-like cells eventually transform into PNH; but MDS and MPD seldom evolve to PNH; 2) AA harboring PNH-like cells may have a better response to immunosuppressive therapy; and 3) PIG-A mutation frequency significantly increased in some human cell lines with genomic instability. However, the clinical significances of these PNH-like cells in MDS, MPD, and AA are unclear. Methods: We prospectively recruit MDS, MPD, and AA patients. Peripheral blood flow cytometry is used to identify GPI-AP deficient blood cells, a proaerolysin-resistant CFC assay is used to select GPI-AP deficient progenitor cells, a novel T cell enrichment assay with proaerolysin selection is used to expand GPI-AP deficient T cells, and RT-PCR assay and DNA sequencing assay are used to identify and analyze particular gene expression deficiency in GPI-AP biosynthesis. Results: Our preliminary data shows that PNH-like cells in AA arise from multipotent HSC harboring PIG-A mutation; in MDS initiated at progenitor harboring PIG-A mutations and are transient; and in MPD caused from PIG-Y gene transcriptional silencing. Interestingly, the PIG-A mutation frequency in 4 MDS harboring PNH-like cells were 10~100 times higher than healthy controls. Furthermore, these 4 MDS and 3 MPD harboring PNH-like cells rapidly transformed into acute myelogenous leukemia. Conclusions: The origins and the clonality of PNH-like cells are different among MPD, MDS, and AA. This may explain why AA often evolves into PNH, but MPD and MDS seldom transform into PNH. PNH-like cell population in MPD and MDS is a marker of genomic instability and may predict a risk of leukemic transformation.
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Affiliation(s)
| | - Jerry L. Spivak
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Alison Moliterno
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Pu JJ, Hu R, Mukhina GL, Carraway HE, McDevitt MA, Brodsky RA. The small population of PIG-A mutant cells in myelodysplastic syndromes do not arise from multipotent hematopoietic stem cells. Haematologica 2012; 97:1225-33. [PMID: 22315493 DOI: 10.3324/haematol.2011.048215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with paroxysmal nocturnal hemoglobinuria harbor clonal glycosylphosphatidylinositol-anchor deficient cells arising from a multipotent hematopoietic stem cell acquiring a PIG-A mutation. Many patients with aplastic anemia and myelodysplastic syndromes also harbor small populations of glycosylphosphatidylinositol-anchor deficient cells. Patients with aplastic anemia often evolve into paroxysmal nocturnal hemoglobinuria; however, myelodysplastic syndromes seldom evolve into paroxysmal nocturnal hemoglobinuria. Here, we investigate the origin and clonality of small glycosylphosphatidylinositol-anchor deficient cell populations in aplastic anemia and myelodysplastic syndromes. DESIGN AND METHODS We used peripheral blood flow cytometry to identify glycosylphosphatidylinositol-anchor deficient blood cells, a proaerolysin-resistant colony forming cell assay to select glycosylphosphatidylinositol-anchor deficient progenitor cells, a novel T-lymphocyte enrichment culture assay with proaerolysin selection to expand glycosylphosphatidylinositol-anchor deficient T lymphocytes, and PIG-A gene sequencing assays to identify and analyze PIG-A mutations in patients with aplastic anemia and myelodysplastic syndromes. RESULTS Twelve of 15 aplastic anemia patients were found to harbor a small population of glycosylphosphatidylinositol-anchor deficient granulocytes; 11 of them were found to harbor a small population of glycosylphosphatidylinositol-anchor deficient erythrocytes, 10 patients were detected to harbor glycosylphosphatidylinositol-anchor deficient T lymphocytes, and 3 of them were detected only after T-lymphocyte enrichment in proaerolysin selection. PIG-A mutation analyses on 3 patients showed that all of them harbored a matching PIG-A mutation between CFU-GM and enriched T lymphocytes. Two of 26 myelodysplastic syndromes were found to harbor small populations of glycosylphosphatidylinositol-anchor deficient granulocytes and erythrocytes transiently. Bone marrow derived CD34(+) cells from 4 patients grew proaerolysin-resistant colony forming cells bearing PIG-A mutations. No glycosylphosphatidylinositol-anchor deficient T lymphocytes were detected in myelodysplastic syndrome patients. CONCLUSIONS In contrast to aplastic anemia and paroxysmal nocturnal hemoglobinuria, where PIG-A mutations arise from multipotent hematopoietic stem cells, glycosylphosphatidylinositol-anchor deficient cells in myelodysplastic syndromes appear to arise from more committed progenitors.
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Affiliation(s)
- Jeffrey J Pu
- Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Lu Y, Xu WH, Xie YX, Zhang X, Pu JJ, Qi YX, Li HP. Isolation and characterization of nucleotide-binding site and C-terminal leucine-rich repeat-resistance gene candidates in bananas. Genet Mol Res 2011; 10:3098-108. [PMID: 22194165 DOI: 10.4238/2011.december.15.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Commercial banana varieties are highly susceptible to fungal pathogens, as well as bacterial pathogens, nematodes, viruses, and insect pests. The largest known family of plant resistance genes encodes proteins with nucleotide-binding site (NBS) and C-terminal leucine-rich repeat (LRR) domains. Conserved motifs in such genes in diverse plant species offer a means for the isolation of candidate genes in banana that may be involved in plant defense. Six degenerate PCR primers were designed to target NBS and additional domains were tested on commercial banana species Musa acuminata subsp malaccensis and the Musa AAB Group propagated in vitro and plants maintained in a greenhouse. Total DNA was isolated by a modified CTAB extraction technique. Four resistance gene analogs were amplified and deposited in GenBank and assigned numbers HQ199833-HQ199836. The predicted amino acid sequences compared to the amino acid sequences of known resistance genes (MRGL1, MRGL2, MRGL3, and MRGL4) revealed significant sequence similarity. The presence of consensus domains, namely kinase-1a, kinase-2 and hydrophobic domain, provided evidence that the cloned sequences belong to the typical non-Toll/interleukin-1 receptor-like domain NBS-LRR gene family.
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Affiliation(s)
- Y Lu
- College of Natural Resources and Environment, South China Agriculture University, Wushan, China
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40
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Pu JJ, Mukhina G, Wang H, Savage WJ, Brodsky RA. Natural history of paroxysmal nocturnal hemoglobinuria clones in patients presenting as aplastic anemia. Eur J Haematol 2011; 87:37-45. [PMID: 21447004 DOI: 10.1111/j.1600-0609.2011.01615.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the natural history of paroxysmal nocturnal hemoglobinuria (PNH) clones in patients with acquired aplastic anemia (AA). PATIENTS AND METHODS Twenty-seven patients with AA and a detectable PNH clone were monitored for a median of 5.7 years (range 1.5-11.5 years). Twenty-two patients received high-dose cyclophosphamide (HiCy) therapy. The erythrocyte and granulocyte PNH clone sizes were measured using flow cytometry and analyzed via CellQuest software. PE-conjugated anti-glycophorin A, anti-CD15, FITC-conjugated anti-CD59, and FLAER staining were used to define glycosylphosphatidylinositol-AP-deficient cells. RESULTS We found a linear relationship between PNH clone size and the development of intravascular hemolysis, assessed by lactate dehydrogenase (LDH) values (Pearson correlation coefficient = 0.80, P < 0.001 for erythrocyte PNH clones; and Pearson correlation coefficient = 0.73, P < 0.0001 for granulocyte PNH clones). An erythrocyte PNH size of 3-5% and granulocyte PNH size of 23% were the thresholds to predict hemolysis as measured by an elevated LDH (receiver operating characteristic analyses with AUC = 0.96 for erythrocyte PNH clone sizes and AUC = 0.88 for granulocyte PNH clone sizes). Patients with small (≤15%) initial PNH clone sizes were less likely to develop an elevated LDH (mean ± SD: 236.9 ± 109.9 vs. 423.1 ± 248.8; P = 0.02). Over time, the PNH clone sizes remained stable in 25.9% of patients; 48.1% experienced a rise in the PNH clone size; and 25.9% experienced a decrease. CONCLUSION The risk of developing clinically significant PNH after HiCy therapy appears to be low in AA patients with PNH clones, especially for those with small initial PNH clones and for those who respond to HiCy therapy.
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Affiliation(s)
- Jeffrey J Pu
- Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disease that presents with protean manifestations. Clinical and laboratory investigation over the past 25 years has uncovered most of the basic science underpinnings of PNH and has led to the development of a highly effective targeted therapy. PNH originates from a multipotent hematopoietic stem cell (HSC) that acquires a somatic mutation in a gene called phosphatidylinositol glycan anchor biosynthesis, class A (PIG-A). The PIG-A gene is required for the first step in glycosylphosphatidylinositol (GPI) anchor biosynthesis. Failure to synthesize GPI anchors leads to an absence of all proteins that utilize GPI to attach to the plasma membrane. Two GPI-anchor proteins, CD55 and CD59, are complement regulatory proteins; their absence on the surface of PNH cells leads to complement-mediated hemolysis. The release of free hemoglobin leads to scavenging of nitric oxide and contributes to many clinical manifestations, including esophageal spasm, fatigue, and possibly thrombosis. Aerolysin is a pore-forming toxin that binds GPI-anchored proteins and kills normal cells, but not PNH cells. A fluorescinated aerolysin variant (FLAER) binds GPI-anchor and serves as a novel reagent diagnosing PNH. Eculizumab, a humanized monoclonal antibody against C5, is the first effective drug therapy for PNH.
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Affiliation(s)
- Jeffrey J Pu
- Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Abstract
Gallbladder carcinosarcoma is a rare gastrointestinal tract malignant tumour, which contains both epithelial cancer component and mesenchymal sarcoma component. Because of its unique anatomic location and unspecific medical presentation, preoperative diagnosis is difficult. The prognosis of gallbladder carcinoma is poor with median survival time of 5.5 months. T- and N-staging system has no role in cancer prognostic stratification. Currently, we still have limited experience in managing this form of notorious cancer. Surgical resection is the common practice in treating gallbladder carcinoma though recurrence rate is high (80%). Here, we report a 59-year-old female with new diagnosed gallbladder carcinosarcoma. She was found to have a carcinosarcoma masse at gallbladder extending into proximal bile ducts with no metastatic lesion. She underwent a radical cholangiocholecystocholedochectomy and Roux-en-Y hepatocholangioduodenostomy. Postsurgery, she received six cycles of adjuvant chemotherapy consisting of oxaliplatin and 5-fluorouracil. She maintains in complete remission 6 months after adjuvant chemotherapy.
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Affiliation(s)
- Jeffrey J Pu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, USA.
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Abstract
BACKGROUND Kell and XK, two distinct red blood cell membrane proteins, are linked by a disulfide bond and form the Kell blood group complex. Kell surface antigens are expressed early during erythropoiesis but the onset of expression of XK which carries the Kx antigen is unknown. STUDY DESIGN AND METHODS To determine whether Kell and XK are synchronously expressed, sorted human hematopoietic progenitor cells and mouse progenitor cells of defined lineage were studied. To determine the onset of expression, human marrow and cord blood cells were sorted into three subpopulations, representing stem, multipotent, and erythroid progenitor cells, and the expression of Kell and XK was determined by reverse transcription-polymerase chain reaction (RT-PCR) and fluorescence-activated cell sorting (FACS) analysis. Mouse Kell and XK transcripts were determined by cDNA blotting of progenitor cells of defined lineage. RESULTS By RT-PCR, human peripheral blood progenitor cells had weak expression of Kell and XK transcripts but FACS analysis did not detect surface antigens. Kell and XK transcripts are expressed in multipotent progenitor cells and these cells express Kell surface antigens. The expression of Kx antigen in progenitor cells was not determined owing to nonspecific reactions with the antibody. By cDNA blotting, mouse Kell expression was detected in bipotential megakaryocytes-erythroid cells and in colony-forming units-erythroid (CFU-E) and burst-forming units-erythroid (BFU-E), whereas XK was only detected in CFU-E and BFU-E. CONCLUSION Both Kell and XK transcripts occur early during erythropoiesis; however, expression may not be coincident because, in mice, Kell transcripts, but not XK, occur in bipotential megakaryocytes-erythroid progenitor cells.
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MESH Headings
- Amino Acid Transport Systems, Neutral/blood
- Amino Acid Transport Systems, Neutral/chemistry
- Amino Acid Transport Systems, Neutral/genetics
- Amino Acid Transport Systems, Neutral/metabolism
- Animals
- Antigens, Bacterial/blood
- Antigens, Bacterial/chemistry
- Antigens, Bacterial/genetics
- Antigens, Bacterial/metabolism
- Antigens, CD34/metabolism
- Antigens, Surface/blood
- Antigens, Surface/chemistry
- Antigens, Surface/genetics
- Antigens, Surface/metabolism
- Blood Group Antigens/chemistry
- Blood Group Antigens/genetics
- Blood Group Antigens/metabolism
- Bone Marrow Cells/immunology
- Cell Lineage
- DNA, Complementary
- Disulfides/chemistry
- Erythroid Precursor Cells/immunology
- Erythroid Precursor Cells/metabolism
- Erythropoiesis/immunology
- Fetal Blood/immunology
- Hematopoietic Stem Cells/immunology
- Hematopoietic Stem Cells/metabolism
- Humans
- Infant, Newborn
- Kell Blood-Group System/blood
- Kell Blood-Group System/metabolism
- Leukocytes, Mononuclear/immunology
- Megakaryocytes/metabolism
- Membrane Proteins/blood
- Membrane Proteins/metabolism
- Mice
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Affiliation(s)
- Jeffrey J Pu
- Lindsley F. Kimball Research Institute of the New York Blood Center, New York, New York 10021, USA
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Pu JJ, Li C, Rodriguez M, Banerjee D. Cloning and structural characterization of ECTACC, a new member of the transforming acidic coiled coil (TACC) gene family: cDNA sequence and expression analysis in human microvascular endothelial cells. Cytokine 2001; 13:129-37. [PMID: 11161455 DOI: 10.1006/cyto.2000.0812] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Erythropoietin (Epo) transduces mitogenic and chemoattractant signals to human endothelial cells. Identifications of Epo-responsive genes are important for understanding the molecular nature of Epo signaling in endothelial cells. The effects of Epo on differential expression of various genes were examined in human microvascular endothelial cells (HMVEC) by differential display reverse transcriptase polymerase chain reaction (RT-PCR). In the current study we obtained from Epo-treated HMVEC a cDNA fragment with characteristics of the 3' end of mRNA. Using the cDNA fragment, we then selectively isolated a full-length clone by screening an unamplified endothelial cell cDNA library followed by 5' rapid amplification of cDNA ends by polymerase chain reaction (RACE-PCR). The nucleotide sequence of the longest cDNA revealed an open reading frame of 3311 nucleotides that encodes a protein consisting of approximately 906 amino acids with a predicted MW of approximately 100 kDa. The nucleotide sequence of the cDNA is nearly identical to that of transforming acidic coiled coil-containing (TACC2) and anti-zuai-1 (AZU-1) cDNA clones except at the 5'- and 3'-ends. Northern blot analysis showed an increase in endothelial-TACC-related mRNA levels in Epo-treated cells in comparison to that of the control cells. Endothelial-TACC-related mRNA was highly expressed in heart and skeletal muscle tissue. Placenta and brain tissue exhibited low levels of expression of endothelial-TACC-related gene. Southern blot analysis of genomic DNA from somatic cell hybrids showed that endothelial-TACC-related cDNA maps to chromosome 10. Immunofluorescence microscopy and the occurrence of several putative phosphorylation and SH3 binding sites on the deduced protein suggest that endothelial-TACC-related protein may be involved in Epo signaling cascades in endothelial cells.
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MESH Headings
- Amino Acid Sequence
- Animals
- Base Sequence
- Carrier Proteins
- Cells, Cultured
- Chromosome Mapping
- Chromosomes, Human, Pair 10/genetics
- Cloning, Molecular
- Cricetinae
- DNA, Complementary/biosynthesis
- DNA, Complementary/isolation & purification
- Endothelium, Vascular/chemistry
- Endothelium, Vascular/cytology
- Endothelium, Vascular/metabolism
- Fetal Proteins
- Fluorescent Antibody Technique, Indirect
- Gene Amplification
- Gene Expression Profiling
- Gene Library
- Humans
- Mice
- Microcirculation/chemistry
- Microcirculation/cytology
- Microcirculation/metabolism
- Microtubule-Associated Proteins/chemistry
- Microtubule-Associated Proteins/genetics
- Microtubule-Associated Proteins/isolation & purification
- Microtubule-Associated Proteins/metabolism
- Molecular Sequence Data
- Multigene Family
- Nuclear Proteins
- RNA, Messenger/biosynthesis
- Sequence Analysis, DNA
- Tumor Suppressor Proteins
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Affiliation(s)
- J J Pu
- Department of Membrane Biochemistry II, The Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10021, USA
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